Provider Demographics
NPI:1821142696
Name:JENNEWEIN, BJ (DC)
Entity Type:Individual
Prefix:DR
First Name:BJ
Middle Name:
Last Name:JENNEWEIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:STEVE
Other - Middle Name:JEFF
Other - Last Name:JENNEWEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC, MA, MS, SBN
Mailing Address - Street 1:25448 NARBONNE AVE
Mailing Address - Street 2:
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-2124
Mailing Address - Country:US
Mailing Address - Phone:310-326-2804
Mailing Address - Fax:310-534-5166
Practice Address - Street 1:25448 NARBONNE AVE
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-2124
Practice Address - Country:US
Practice Address - Phone:310-326-2804
Practice Address - Fax:310-534-5166
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16429111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT18331Medicare UPIN
CADC16429Medicare ID - Type UnspecifiedDOCTOR OF CHIROPRACITC #